Respiration During Exercise

Dr. Hazrat Bilal MalakandiDPT (IPM&R, KMU)

Introduction• Pulmonary respiration

– Ventilation

– Exchange of O2 and CO2 in the lungs

• Cellular respiration

– O2 utilization and CO2 production by the tissues

• Purposes of the respiratory system during exercise

– Gas exchange between the environment and the body

– Regulation of acid-base balance during exercise

Function of the Lung• Means of gas exchange between the

external environment and the body• Replacing O2• removing CO2• Regulation of acid-base balance

• Ventilation– Mechanical process of moving air into and out of lungs

Structure of the Respiratory System

• Organs

– Nose and nasal cavities

– Pharynx and larynx

– Trachea and bronchial tree

– Lungs

Alveoli Site of gas exchange

• Diaphragm

– Major muscle of inspiration

• Lungs are enclosed by membranes called pleura

– Visceral pleura

On outer surface of lung

– Parietal pleura

Lines the thoracic wall

– Intrapleural space

-- Intrapleural pressure is lower than atmospheric

-- Prevents collapse of alveoli

Conducting and Respiratory Zones

• Conducting zone

• Conducts air to respiratory zone

• Humidifies, warms, and filters air

• Components:

– Trachea

– Bronchial tree

– Bronchioles

• Respiratory zone

• Exchange of gases between air and blood

• Components:

– Respiratory bronchioles

– Alveolar sacs

Surfactant prevents

alveolar collapse

ConductingandRespiratoryZones

Bronchial Tree

Mechanics of Breathing

• Movement of air occurs via bulk flow

– Movement of molecules due to pressure difference

• Inspiration

– Diaphragm pushes downward, ribs lift outward

– Volume of lungs increases

– Intrapulmonary pressure lowered

• Expiration

– Diaphragm relaxes, ribs pulled downward

– Volume of lungs decreases

– Intrapulmonary pressure raised

The Muscles of Respiration

Respiratory Muscles and Exercise

• Do respiratory muscles fatigue during exercise?

– Historically believed that respiratory muscles do not fatigue during exercise

– Current evidence suggests that respiratory muscles do fatigue during exercise

Prolonged (>120 minutes)

High-intensity (90–100% VO2 max)

• Do respiratory muscle adapt to training?

– Yes!

-- Increased oxidative capacity improves respiratory muscle endurance

-- Reduced work of breathing

Exercise-Induced Asthma

• Asthma results in bronchospasm

– Narrowing of airways

Increased work of breathing

Shortness of breath (dyspnea)

• Exercise-induced asthma

– During or immediately following exercise

– May impair exercise performance

Exercise and Chronic ObstructiveLung Disease

• Chronic obstructive lung disease (COPD)

– Increased airway resistance

Due to constant airway narrowing

– Decreased expiratory airflow

• Includes two lung diseases:

– Chronic bronchitis Excessive mucus blocks airways

– Emphysema Airway collapse and increased

resistance

• Increased work of breathing– Leads to shortness of breath

– May interfere with exercise and activities of daily living

Pulmonary Ventilation

• The amount of air moved in or out of the lungs per minute (V)

– Tidal volume (VT) Amount of air moved per breath

– Breathing frequency (f) Number of breaths per minute

V = VT x f

• In a 70-kg man the V at rest is generally around 7.5 liters/minute, with a tidal volume of 0.5 liter and a frequency of 15.

• During maximal exercise, ventilation may reach 120 to 175 liters per minute, with a frequency of 40 to 50 and a tidal volume of approximately 3 to 3.5 liters.

– Alveolar ventilation (VA) Volume of air that reaches the respiratory zone

– Dead-space ventilation (VD) Volume of air remaining in conducting airways

V = VA + VD

Pulmonary Volumes and Capacities

• Assignment

Spirometry

• Measurement of pulmonary volumes and rate of expired airflow

• Useful for diagnosing lung diseases

– Chronic obstructive lung disease (COPD)

Spirometric tests

– Vital capacity (VC) Maximal volume of air that can be expired after maximal inspiration

– Forced expiratory volume (FEV1) Volume of air expired in 1 second during maximal expiration

– FEV1/VC ratio ≥80% is normal

Partial Pressures of O2 and CO2

Ventilation-Perfusion Ratiothe ratio between the amount of air

getting to the alveoli (the alveolar ventilation, V, in ml/min) and the amount of blood being sent to the lungs (the cardiac output or Q - also in ml/min).

– Ideal: ~1.0

• Apex of lung– Underperfused (ratio <1.0)

• Base of lung– Overperfused (ratio >1.0).

• During exercise– Light exercise improves V/Q ratio

– Heavy exercise results in V/Q inequality

O2 Transport in the Blood

• 99% of O2 is transported bound to hemoglobin (Hb)

– Oxyhemoglobin: Hb bound to O2

– Deoxyhemoglobin: Hb not bound to O2

• Amount of O2 that can be transported per unit volume of blood is dependent on the Hb concentration– Each gram of Hb can transport 1.34 ml O2

Blood Flow to the Lung

• Pulmonary circuit

– Same rate of flow as systemic circuit

– Lower pressure

• When standing, most of the blood flow is to the base of the lung

– Due to gravitational force

• During exercise, more blood flow to apex

The Pulmonaryand SystemicCirculation

Oxyhemoglobin Dissociation Curve

• Deoxyhemoglobin + O2 ↔ Oxyhemoglobin

• Direction of reaction depends on:

– PO2 of the blood

– Affinity between Hb and O2

• At the lung– High PO2 = formation of oxyhemoglobin

• At the tissues– Low PO2 = release of O2 to tissues

Oxygen-Hemoglobin Dissociation Curve

Effect of pH, Temperature on the O2-Hb Dissociation Curve

• pH

– Decreased pH lowers Hb-O2 affinity

– Results in a “rightward” shift of the curve

Favors “offloading” of O2 to the tissues

• Temperature

– Increased blood temperature lowers Hb-O2 affinity

– Results in a “rightward” shift of the curve

O2 Transport in Muscle

• Myoglobin (Mb)

– Shuttles O2 from the cell membrane to the mitochondria

• Mb has a higher affinity for O2 than hemoglobin

– Even at low PO2

– Allows Mb to store O2

O2 reserve for muscle

CO2 Transport in the Blood at the Tissue

The Transition From Rest to Exercise

• At the onset of constant-load submaximal exercise:

– Initially, ventilation increases rapidly increase. Then, a slower rise toward steady state

– PO2 and PCO2 are relatively unchanged

-- Slight decrease in PO2 and increase in PCO2

The Transition From Rest to Exercise

Prolonged Exercise in a HotEnvironment

• During prolonged submaximal exercise in a hot/humid environment:

– Ventilation tends to drift upward

Increased blood temperature affects respiratory control center

Exercise in a Hot/Humid Environment

Incremental Exercise in an Untrained Subject

• Ventilation

– Linear increase up to ~50–75% VO2 max

– Exponential increase beyond this point

– Ventilatory threshold (Tvent)

Inflection point where VE increases exponentially

• PO2

– Maintained within 10–12 mmHg of resting value

Incremental Exercise in an Elite Athlete

• Ventilation

– Tvent occurs at higher % VO2 max

• PO2

– Decrease of 30–40 mmHg at near-maximal work

• Hypoxemia• – Due to:

• Ventilation/perfusion mismatch• Short RBC transit time in pulmonary

capillary due to high cardiac output

Control of Ventilation at Rest

• Inspiration and expiration

– Produced by contraction and relaxation of diaphragm

• Controlled by somatic motor neurons in the spinal cord

– Controlled by respiratory control center

• In medulla oblongata

Respiratory Control Center

• Stimulus for inspiration comes from four respiratory rhythm centers

– In Medulla• preBötzinger Complex and

retrotrapezoidal nucleus

– In Pons• Pneumotaxic center and caudal

pons

The Brain Stem Respiratory ControlCenters

Input to the Respiratory Control Center

• Humoral chemoreceptors

– Central chemoreceptors• Located in the medulla• ↑ PCO2 and H+ concentration in

cerebrospinal fluid - ↑ in ventilation

– Peripheral chemoreceptors• Aortic and carotid bodies• PO2, PCO2, H+, and K+ in blood

• Neural input– From motor cortex and skeletal muscle

• mechanoreceptors

The Location ofthe PeripheralChemoreceptors

Effect of Arterial PCO2 on Ventilation

Effect of Arterial PO2 on Ventilation

Ventilatory Control During Exercise

• Submaximal exercise• Primary drive:

• Higher brain centers (central command)

• Fine tuned¨ by:• Humoral chemoreceptors• Neural feedback from muscle

Ventilatory Control During Exercise

• Heavy exercise• A linear rise in VE

• Increasing blood H+ (from lactic acid) stimulates carotid bodies

• Also K+, body temperature, and blood catecholamines may contribute

Training Reduces the VentilatoryResponse to Exercise

• No effect on lung structure

• Ventilation is lower during exercise following training

– Exercise ventilation is 20–30% lower at same submaximal work rate

• Mechanism:

– Changes in aerobic capacity of locomotor muscles

• Result in less production of lactic acid• Less afferent feedback from muscle to

stimulate breathing

Effects of Endurance Training onVentilation During Exercise

Effect of Training on Ventilation

• No effect on lung structure and function at rest

• Normal lung exceeds demand for gas exchange

– Adaptation is not required for the lung to maintain blood-gas homeostasis

• One exception: Elite endurance athletes

– Failure of lung to adapt to training results in hypoxemia

Does the Pulmonary System LimitExercise Performance?

• Low-to-moderate intensity exercise

– Pulmonary system not seen as a limitation

• Maximal exercise

– Historically not thought to be a limitation in healthy individuals at sea level• New evidence that respiratory muscle

fatigue does occur during high intensity exercise (>90% VO2 max)

– May be limiting in elite endurance athletes• 40–50% experience hypoxemia